Cost-effective management of type 2 diabetes: providing quality care in a cost-constrained environment.

John Deere Health Care provides health coverage to 20,000 diabetic members in 5 states. Medical costs for those members are approximately 3 times higher than costs for nondiabetic members. Last year, John Deere Health Care introduced an integrated diabetes disease management program that includes telephone and mail reminders (managed by a vendor) for asymptomatic diabetic individuals, case management (managed by the plan) for diabetic members with complications or risks, and quarterly patient-specific mailings that are sent to providers. After 1 year of operation, testing rates increased 19% for hemoglobin A1c (HbA1c), 20% for lipids, and 78% for microalbumin. The actual mean HbA1c level decreased 0.5%, hospital admission rates decreased 22%, and hospital days were reduced 34%. Overall, the total medical costs per diabetic patient were reduced approximately 12%. Despite system cost increases for pharmacy costs, vendor contracting, case management administration, and patient and physician education, the potential for long-term quality improvement and considerable hospital cost reduction is high when such a plan is instituted. The program at John Deere Health Care is expanding and coverage has been enhanced.